Adult ADHD Treatment
Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder that affects around one in 20 adults. Until recently, scientists thought that children outgrew ADHD during adolescence due to developmental changes in their brains. But now, they believe that seven out of 10 children with ADHD will mature into adults with ADHD. Adults with ADHD might have difficulty following directions, remembering information, concentrating, or organizing tasks. Adult ADHD can cause associated behavioral, emotional, social, vocational, and academic problems without management.
Although it can negatively affect behavior, thinking, and attention, it is highly treatable with behavior therapy and medication.
Attention Deficit Hyperactivity Disorder (ADHD) in Adults
ADHD can affect a person’s overall quality of life. Some people with ADHD may find it challenging to maintain relationships or keep a job. If their condition was undiagnosed and untreated in childhood, they might not have done well in school or developed chronic procrastination. Several ADHD-related factors can lead to chronic procrastination, including distractibility, forgetfulness, disorganization, problems with prioritizing, sequencing, and time management. A lifetime of grappling with this behavioral disorder sometimes causes low self-esteem.
Some people with ADHD experiment with drugs or alcohol to try and cope with their feelings. People with ADHD are more likely to have personality disorders and other psychological problems, such as anxiety or mood disorders. The good news is that these co-occurring disorders can be treated successfully in tandem with ADHD treatment. We are here to treat you with dignity and respect; we understand the obstacles you have faced and know that many try off-label treatments before exploring medically supervised, sustainable and consistent treatment that our providers at Kentucky Mental Health Care can offer. We want your long-term success and partner with you to get there.
We want you to know too that being neuro-atypical can also have its advantages. Adults with managed ADHD often show great imagination, creative flair, and deep personal connection and understanding. Well-managed adults with ADHD can be highly productive and results-oriented. You can get there, too; let us help make things a bit easier by helping you to remove the obstacles getting in your way.
ADHD Symptoms in Adults
What are symptoms related to adult attention deficit hyperactivity disorder (ADHD)?
Attention deficit hyperactivity disorder (ADHD) symptoms continue as problems into adulthood for more than 60 percent of children with ADHD. The following behaviors and problems might stem directly from ADHD or might be the result of related adjustment difficulties:
- Chronic lateness and forgetfulness
- Lack of prioritizing & organizational skills
- Low self-esteem because of unmanaged ADHD outcomes and daily setbacks
- Employment problems
- Difficulty controlling anger
- Impulsiveness and impatience
- have unpredictable mood swings
- not seem to listen when spoken to directly
- Notice someone is speaking to you only after you’ve missed the first part of what was said, then scrabble to remember the first part of the sentence while also listening to catch up.
- not follow spoken multi-step instructions or finish tasks
- find it hard to organize and prioritize tasks and activities
- avoid sustained mental effort in work, excessive procrastination
- lose things like keys, paperwork, and items needed for tasks
- be easily distracted by other stimuli, hyper-observant
- Be hyperfocused, but lose sight of external considerations
- difficulty shifting attention from one thing to another
- have sleep difficulties.
If these difficulties are not managed appropriately, they can cause adults’ emotional, social, occupational, and academic problems.
Getting an Adult ADHD Diagnosis
What test do I take to get a diagnosis for adult attention deficit hyperactivity disorder (ADHD)?
It is important to obtain an accurate diagnosis of ADHD. Symptoms of ADHD can be similar to symptoms of anxiety, depression, or other mental illness. Kentucky Mental Health providers are adept at evaluating your specific needs and design a personalized treatment plan for long-term success.
There is no biological test to see whether or not a person has ADHD. Diagnosis is currently made by subjectively rating the person’s behavior in settings such as home and school.
Diagnosis may include:
- ruling out other psychological problems that have similar symptoms to ADHD
- Understanding if a person with ADHD may also have alcohol or drug problems which can be co-treated
- rating the person’s current behavior and lifestyle
- checking back to see if the person showed ADHD symptoms in childhood
- interviewing their partner, family, friends, and others about the person’s behavior
Three different types of ADHD have been identified based on criteria from the American Psychiatric Association. These are:
- Predominantly inattentive presentation.
- Predominantly hyperactive-impulsive presentation.
- Combined presentation (inattentive and hyperactive-impulsive symptoms are present).
Other psychological conditions, such as depression or anxiety, can also accompany ADHD in adults.
Adult ADHD Treatment
How is attention deficit hyperactivity disorder (ADHD) in adults treated?
Although there is no cure for the disorder, ADHD can be successfully treated. There are several different approaches for treating adults, but generally, some combination of medication and behavioral therapy yields the best results.
Medication for ADHD
Prescription drugs used to treat ADHD in children are usually effective for most adults with the predominantly inattentive form of ADHD. However, the dosage and frequency of medications may have to be adjusted early during the course of treatment. It is essential to match the needs of the person with ADHD with the characteristics of the drug.
The primary prescription medications prescribed for ADHD are psychostimulants, antidepressants, and nonstimulant drugs. These treatments affect the neurotransmitters that send signals to brain cells.
Psychostimulants are the medications of choice in treating ADHD. The two types that are most commonly used are amphetamine and methylphenidate. Mixed amphetamine salts are marketed under the brand name Adderall®. Methylphenidate is sold under the brand names Ritalin®, Concerta®, Metadate®, Vyvanse®, and others. Immediate release sustained released and extended-release forms of amphetamine and methylphenidate are available. The dosage and frequency of these medications may have to be adjusted to maximize their effectiveness. Extended-release formulations are recommended over immediate-release formulations.
In some instances, if psychostimulants are ineffective or the person has a co-existing psychological disorder that may be affected by stimulant treatment, other medications might be prescribed.
Adderall vs. Vyvanse: A Comparison
A brief comparison follows based on the books Attention Deficit Hyperactivity Disorder Handbook: A Physician’s Guide to ADHD and Pharmacovigilance in Psychiatry.
- Adderall was approved for use in 1996; Vyvanse was approved for use in 2007.
- Adderall is listed as a psychostimulant; Vyvanse is also listed as a psychostimulant.
- The approved uses for Adderall include the treatment of ADHD and narcolepsy; the approved uses for Vyvanse include treating ADHD and binge eating disorder.
- The active ingredients in Adderall are dextroamphetamine (about 75 percent of the drug) and levoamphetamine (about 25 percent of the drug); the active ingredient in Vyvanse is lisdexamfetamine.
- Adderall comes in an immediate-release form and an extended-release form; Vyvanse comes in a capsule form that is an extended-release version.
- The duration of action for the immediate-release version of Adderall is about 4–6 hours, whereas the extended-release version lasts about 12 hours. The duration of effects for Vyvanse is about 10–13 hours, though some studies report it is up to 14 hours.
- Both drugs have a very similar side effect profile. However, Vyvanse is a prodrug, an inert substance that is metabolized in the body to become an active medication. This means that the side effects from Vyvanse are considered to be less harsh.
- These drugs are considered potential drugs of abuse; however, because Vyvanse is a prodrug and takes longer to metabolize in the system than Adderall, it is considered to have a lower risk of abuse.
- Adderall functions by inhibiting the reuptake of the excitatory neurotransmitters dopamine and norepinephrine and releasing dopamine and norepinephrine from storage sites.
- The lisdexamfetamine in Vyvanse is metabolized into dextroamphetamine and then functions by increasing the availability of dopamine and norepinephrine in the central nervous system.
- The half-life of Adderall is about 11–13 hours; the half-life of the Vyvanse is about 10–12 hours.
- Adderall can be obtained in a generic version that can be relatively inexpensive; there is currently no generic Vyvanse available.
Antidepressants: Drugs such as tricyclic antidepressants, monoamine oxidase inhibitors, bupropion (Wellbutrin®), and venlafaxine (Effexor®) increase norepinephrine levels in the brain and have a positive effect on the symptoms of ADHD. These drugs are not approved by the FDA for this indication, although they are used off-label.
Nonstimulants: These medications may be required when a patient does not respond to stimulants or has an adverse reaction to them. They may also be used for people with co-existing psychiatric conditions. Atomoxetine (Strattera®) was the first nonstimulant drug approved by the U.S. Food and Drug Administration to treat ADHD in adults. Guanfacine (Intuniv®, Tenex®) is another example of a nonstimulant medication.
Complementary Medications for ADHD
Other medications are sometimes prescribed to manage co-occurring disorders, such as sleep, anxiety, substance abuse disorder (addiction), or mood disorders.
Dosage for ADHD Medications
The prescribing doctor should always supervise any changes to medications. They may need to adjust the dosage or type for an individual to get the best control of ADHD symptoms while minimizing possible side effects. For both dexamphetamine and methylphenidate, the dosage may be gradually increased over three or four weeks, using half tablets if necessary.
Side Effects of ADHD Medication
The main short-term side effects of stimulants are poor weight gain and decreased appetite. Some others include:
- sleeping problems, such as delayed sleep onset
- stomach pains
- nausea and vomiting
- dry mouth
- high blood pressure
- tachycardia (increased heart rate)
- emotional changes such as irritability, depression, nervousness, or anxiety
- hallucinations (seeing or hearing things that are not really there) or psychotic symptoms (major mental illness)
- development or worsening of tics (repeated, uncontrolled muscle movement, often in the face).
What is a Co-Occurring Disorder?
A co-occurring disorder refers to when one person has two or more mental health disorders or medical illnesses. These co-occurring disorders may overlap and begin simultaneously, or one may appear before or after the other.
There is a strong link between SUDs (Substance Use Disorder) and other mental health disorders. About half of people with one disorder will eventually develop at least one more co-occurring mental health condition in their lifetime. Co-occurring disorders can also worsen each other’s level of severity. Researchers have identified three possible mechanisms that may explain why co-occurring disorders are so prevalent:
Common risk factors for SUDs and other mental health conditions often overlap. These may include genetics and environmental factors, such as exposure to trauma, making a person more likely to develop these issues.
Mental illness can lead to substance abuse as a way of coping with symptoms. This concept is often casually termed “self-medicating,” however that label may be misleading because while substance use can mask symptoms, they may also at the same time exacerbate symptoms in both the short and long terms.
Substance use can cause changes in areas of the brain disrupted by mental health disorders, which can increase someone’s likelihood of developing symptoms of a mental disorder that affects that brain. The areas of the brain affected by substance use seem to correlate with areas also associated with impulse-control, mood, anxiety disorders, and schizophrenia.
Researchers have studied rates of co-occurring disorders for decades. They have identified that certain mental health disorders have been linked to substance use disorders more often than others. Mental health conditions that are most likely to occur alongside SUDs include, but are not limited to:
ADHD is associated with an earlier age at the onset of substance use and a higher likelihood of using various substances. Brook et al. 20 reported that the diagnosis of ADHD poses an increased risk of SUD into adulthood; meeting criteria for a diagnosis of ADHD in adolescence is associated with developing SUDs in a subject’s 20s and 30s. Among individuals with ADHD, the number of inattention, hyperactivity, and impulsivity symptoms exhibited is positively correlated with the risk of substance use.
Approximately 18% of the general population also have a co-occurring anxiety disorder of some type. Social anxiety disorders have an especially strong link to marijuana use problems. Generalized anxiety disorder, social anxiety disorder, and panic disorder are all associated with an increased risk of co-occurring disorders.
About 20% of the general population with a SUD also have one or more mood disorders, such as bipolar disorder or depression.
Approximately 10-15% of the general population have a personality disorder, compared to a prevalence rate of about 35-73% in patients treated for addiction. The personality disorders most commonly found in those with SUD include antisocial, borderline, avoidant, and paranoid.
According to one national survey, people with PTSD were, relative to those without PTSD, as much as four times more likely to also meet the criteria for a substance use disorder.
The Link between ADHD and Addiction
An understanding of the basics of ADHD makes for a more informed discussion of ADHD and addiction. At the outset, however, it is critical to note that there is no evidence that one disorder causes the other. However, the two can coexist. A person experiencing a substance use disorder with an ADHD diagnosis is clinically considered a co-occurring disorder. As a rule, both conditions must be treated simultaneously for either to be effectively healed or managed. In any case of a co-occurring disorder, the best approach is to seek co-treatment at Kentucky Recovery to accommodate co-occurring disorders.
Research shows a connection between ADHD and addiction. According to some studies, when compared to the general population, children with ADHD face an increased risk of becoming dependent on alcohol or other drugs when they are adults. The following facts and statistics further support the linkage:
- Among adults who have an alcohol use disorder, ADHD is 5-10 times more common.
- Among adults who are receiving recovery services for alcohol or other substance abuse, about 25 percent have ADHD.
- Children with ADHD are more likely than children without the disorder to initiate alcohol abuse or marijuana overuse in their teens.
- Young adults (with an average age of 25) who have an ADHD diagnosis are more likely to use alcohol or marijuana excessively than young adults who do not have this disorder.
- When individuals with ADHD are compared to those without this disorder, the ADHD group is more likely to start abusing alcohol and other drugs at an earlier age.
These facts and statistics beg one crucial question: Why do people with ADHD face an increased risk of drug abuse? According to research, the answer lies (in part) in the reduced impulse control and behavioral problems associated with ADHD in general. These side effects may contribute to a person initiating into drugs. The risks are layered. For example, let’s say a teenager with ADHD and behavioral problems skips school. By not being in school during the day, this teen may end up in a social situation that involves drugs. The poor impulse control that goes hand in hand with ADHD may lower this teen’s resistance to the drugs offered.
The risks are not environmental alone. Genes and family can also play a role. Regarding alcohol abuse and ADHD, both conditions tend to run in families, and they may even stem from some of the same genes.
Non-Medication Therapies for ADHD
There are several different approaches for treating adults with ADHD, but generally, some combination of medication and behavioral therapy yields the best results.
What are the types of behavioral treatments for adult attention deficit hyperactivity disorder (ADHD)?
Adult ADHD might be treated with one or more of the following:
- Individual cognitive and behavioral therapy to enhance self-esteem.
- Relaxation training and stress management to reduce anxiety and stress.
- Behavioral “coaching” to teach the person strategies for organizing home and work activities.
- Job coaching or mentoring to support better working relationships and improve on-the-job performance.
- Family education and therapy.
What strategies can help an adult with attention deficit hyperactivity disorder (ADHD) succeed in the workplace?
Some adults with ADHD have benefited from:
- Time-management training;
- Relaxation and stress management training;
- Occupational therapy to teach strategies for organizing home and work activities; and,
- Job coaching or mentoring to support better working relationships and improve on-the-job performance.
Living With ADHD
What quick tips can be offered to help adults with ADHD Inattentive type cope with the day-to-day activities of life?
The following are tips for adults with ADHD, inattentive type, for self-regulating (controlling one’s behaviors, emotions, and thoughts), and regaining control over many daily tasks:
- Request a quiet or private work area; move to an unused conference space or other location with few distractions or noise.
- Wear earphones with soft music to cover up office noise.
- Redirect phone calls to voice mail and return phone calls at set times throughout the day.
- Set aside the first 10 to 20 minutes of your day to organize your tasks for the day.
- Work on and complete one task at a time before moving on to the next one.
- Keep a to-do list in a notebook or on your phone.
- Put appointments in your phone and set up alarm reminders before the event.
- Mark deadlines on calendars as a visible reminder tool.
- Use daily planners or online task organizers to help keep track of tasks and events.
- Use sticky pads to write important notes and place them in appropriate areas where they will be seen.
- If a filing system is needed, use labels or color-coded folders or tabs.
- Set up online automatic payment of bills, so you don’t forget to pay them.
Identify specific areas to place specific items and get into the routine of only placing items in these designated spots.
- Take handwritten notes during meetings, or record them on your phone as a backup and fill in details.
- Break up larger tasks into smaller ones. Reward yourself when each task is completed.
- Take short breaks to prevent boredom – take a short walk, do some stretches, drink some water.
Extended Care ADHD Treatment
Adults taking medication to relieve their ADHD symptoms should see their Kentucky Mental Health Care professional on a set schedule determined by you and your provider. If you choose, you might also find additional success with combined non-medical therapy, and those therapy time-frames are designed around your treatment plan. A Kentucky Recovery plan can also be incorporated for those with substance abuse disorder to help enable a more comprehensive treatment for ADHD.